Dr. Donohue: Lingering pain after injury heals is difficult to treat

DR. PAUL DONOHUESyndicated Columnist

Published Sunday, March 23, 2003

DEAR DR. DONOHUE: I developed reflex sympathetic dystrophy in my right shoulder after surgery done in 1996. I have come to the conclusion that I will be on painkillers forever. Please give me any information you have. -- B.P.

ANSWER: Reflex sympathetic dystrophy, now called complex regional pain syndrome, fills the hearts of doctors with dread and the lives of patients with pain. Its a baffling condition where pain lingers well after an injury has healed. It can occur almost anywhere, even the face and neck, but having it in the shoulder makes life miserable because the shoulder is such a versatile and much-used joint.

One sign that the condition is developing, in addition to protracted pain, is a change in skin color and texture at the site of the injury. The skin turns red, feels warm and perspires. With the passage of time, other changes take place. The skin becomes pale and thin. The joint stiffens, and the pain continues.

The 'sympathetic' of reflex sympathetic dystrophy indicates that the sympathetic nervous system is involved in this syndrome. The sympathetic nervous system operates on its own automatic pilot. We have little to no control over it. It constricts and dilates blood vessels, and it usually does so appropriately. Here, it acts inappropriately. Why? I dont know. (There are some who doubt this explanation of RSD.)

Doctors and physical therapists have to work as a team to get a patient over a bout of this distressing condition. The therapist devises exercises appropriate to each individual's unique circumstances. The doctor prescribes medicines that mitigate the pain.

Gabapentin and amitriptyline can often suppress pain. Lidocaine skin patches worn over the site of pain are another valuable pain reliever. Capsaicin cream applied to the skin over the injury site is another worthwhile treatment. Anesthetizing the sympathetic nerves serving the area of pain is another approach.

When all else fails, a device called a spinal cord stimulator might provide the answer.

Contact the Reflex Sympathetic Dystrophy Syndrome Association. Its number is (877) 662-7737, and its Web site is www.rsds.org.